Thank You! for your interest in employment with Behavioral Health Concepts and our divisions. Please complete the application form below. Fields marked with an asterisk (*) are required.

(If you prefer a paper application, please download and complete this form. Please return the completed form to BHC via either postal mail or fax. )


This form is valid to apply for positions with Behavioral health Concepts, Inc (BHC), ProSelect, Inc, or the Performance Management Solutions Group (PMSG).


General Information
Name:*
          
First Name,    Middle Initial,    Last Name
Social Security #:*:
   For your privacy, we are not requiring you provide your Social Security number online. However, if you are contacted for an interview, you must be willing to provide your Social Security number at that time. Check this box if you agree to these conditions.
Present Address:*
   street address
       city, state zip
How long have you lived at your present address?   
Phone #:* ( ) -
Email Address:  
(you must provide an email address if you wish to receive confirmation that your application was received)
What Position Are You Applying For?*   
How did you hear about this opportunity?*   
    if you selected Other above, please explain:  
     
Please provide a description of any skills, experience, or specialized training that make you a good candidate for the position indicated above*:
   
     

Personal Information
Date of Birth:*    / /
(MM/DD/YYYY)
Select One:

Have you ever been employed by BHC before?*

If yes, give dates:
     

Voluntary Information
Are you able to perform, without accommodations, all the essential functions of this job?
   

If not, what accommodations would enable you to perform all job functions?
     
Are you currently in the military?       Branch:   Rank:
     
Have you ever been convicted of a felony?
    If yes, please explain:
     

Previous Employment

Please list your work experience from your last two (2) employers. List your most recent position first.

Most Recent Position:
Name of Previous Employer*:    

Dates of Employment*:   From / /   To   / /
(MM/DD/YYYY - if the position is ongoing, enter today's date)

Address*:
   street address
       city, state zip
Phone #*: ( ) -
Job Title*:  
Reason for Leaving (be specific)*:
List the jobs you held, duties performed, skills used or obtained, advancements or promotions received while you worked for this company*:
   
     
2nd Most Recent Position:
Name of Previous Employer:    

Dates of Employment:   From / /   To   / /
(MM/DD/YYYY - if the position is ongoing, enter today's date)

Address:
   street address
       city, state zip
Phone #: ( ) -
Job Title:  
Reason for Leaving (be specific):
List the jobs you held, duties performed, skills used or obtained, advancements or promotions received while you worked for this company:
   

Education
Type of School
Name of School
Location
# Years
Completed
Major or Degree
Graduate or Other:
College (Undergraduate):
High School:
         

List Any Professional Licenses:
 
         
BHC (including ProSelect and PMSG) does not discriminate in employment opportunities or practices on the basis of race, color, religion, sex, national origin, age, disability, sexual orientation, veteran status, or any other characteristic protected by law. Employment with BHC (including ProSelect and PMSG) is "employment-at-will" and may be terminated at any time by either party without cause.
     
  By checking the following box, you are attesting that all representations made on this application are true and accurate to the best of your knowledge (this is equivalent to signing your application)*: